Seizures

Question 1

What is a seizure?

Answer 1

clinical manifestation of a paroxysmal cerebral disorder, caused by a synchronous and excessive electrical neuronal discharge, originating from the cerebral cortex

Question 2

What are partial seizures?

Answer 2

originate from a focus in one cerebral hemisphere and usually manifest localized clinical signs.
usually have an acquired cause
may be subdivided into simple partial seizures or complex partial seizures
Simple = no change in conciousness
Complex = change in conciousness

Question 3

What systemic problems can status epilepticus cause?

Answer 3

hypoxemia, hyperthermia, aspiration pneumonia, systemic lactic acidosis, hyperkalemia, hypoglycemia, shock, cardiac arrhythmias, neurogenic pulmonary edema, and acute renal failure.

Question 4

What are some causes of progressive intracranial disease?

Answer 4

inflammation (e.g., granulomatous meningoencephalitis), neoplasia, nutritional alterations (e.g., thiamine deficiency), infection, anomalous entities (e.g., hydrocephalus), and trauma

Question 5

What is a minimum database for seizure patients?

Answer 5

Bloods including fasted glucose
Urinalysis
Thoracic rads

if all normal then an intracranial cause likely - consider MRI, CSF tap, EEG, infectious disease testing

Question 6

If the minimum database is abnormal for a siezure investigation, and you consider an extracranial cause likely, what further tests should be done?

Answer 6

Bile Acids
T4
Insulin
Infectious disease testing
Biopsy of any lesions
Toxicology

Question 7

When may CT be preferred over MRI for intracranial imaging?

Answer 7

When haemorrhage or trauma is suspected

Question 8

What drugs can be used in the acute management of seizures?

Answer 8

Diazepam = first line 0.5-1mg/kg, can be repeated 2-3 times
Phenobarb - give with diazepam as a maintenance drug for once the diazepam wheres off. Multiple small boluses up to a max
Propofol (2nd/3rd line) - need to do CRI and monitor closely parameters, may prevent overt seizuring without stopped seizure activity

Question 9

When would mannitol be considered?

Answer 9

With cerebral oedema - consider in animals presenting in status epilepticus or clusters

Question 10

Outline the use of diazepam

Answer 10

binds to the GABA receptor and enhances neuronal hyperpolarization, reducing neuronal firing. The duration of action is short, so a maintenance anticonvulsant (such as phenobarbital) should be administered concurrently